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Morphine allergy case

by Maaike Blok  – general practitioner VIM committee

At the end of an evening shift on Saturday, the doctor on duty visits an elderly lady of 93 years old in a residential care centre because of some dyspnea and a sore leg. The day before, she started antibiotics through her own GP. At the moment she suffers the most from the  painful leg for which she now only takes paracetamol. The dyspnea turns out to be not too bad. The doctor examines her and decides to give her 5mg of morphine subcutaneously for the pain.

The next morning, the directing physician is called by the pharmacy assistant who has determined that this patient is allergic to morphine. The directing physician will contact the residential care centre. Fortunately, the patient is doing a lot better, she is just a bit nauseous, has no skin rashes.

How could this have happened? Upon inquiry, it appears that the visiting physician prescribed the morphine during the visit without first checking the file or checking with the patient or the care provider whether this patient might be allergic to opiates. In addition, when making the IMM recipe, she did not perceive the warning of the allergy to morphine that appeared as a pop-up.

What can we learn from this? While making a visit, the doctor usually does not have the patient’s file immediately at hand, as usually the laptop is left in the visiting car and is not taken to the patient. This can cause you to administer or leave behind medication that a patient is allergic or intolerant to. It is therefore important to be alert to any allergies/intolerances and to actively check or ask about them.

In addition, Topicus provides a lot of warnings when prescribing medication, where an allergy warning does not differ in layout from a dosage warning, so that it does not stand out as well as it should. Contact has been made with Topicus to ask if this can be done differently. Topicus has included this as a wish and they will see if this can possibly be displayed more clearly.

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